Pengantar Maternitas II

7/30/2019 Pengantar Maternitas II

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Pengantar maternitas II

Irma Nurbaeti


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RUANG LINGKUP FAKTOR-FAKTOR RESIKO

MATERNAL

Didunia AKI 430/100.000 kelahiran hdp

Di ngr berkembang 480/100.000lhr hdp

Negara maju : 27/100.000 lhr hdp

Eropa Utara : 0-11/100.000 lhr hdp

40% ibu mengalami msl obstetrik akut selamakehamilan, persalinan dan postpartum

15% ibu hamil mengalami komplikasi yang mengancamkehidupan


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PENYEBAB KEMATIAN IBU

secara umum

25 %

15%20%

8%

12%

13% 8%

Perdarahan hebat

Penyebab

Tidak

Langsung

Penyebab

Langsung

lainnya

Unsafe

abortionObstructed

labor

Infeksi

Eklampsia


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CATEGORIES OF HIGH-RISK PREGNANCY

MATERNAL AGE AD PARITY FACTORS

1. AGE 16 YEARS OR UNDER

2. NULLIPARA 35 YEARS OR OVER

3. MULTIPARA 40 YEARS OR OVER4. INTERVAL OF 8 YEARS OR MORE SINCE LAST

PREGNANCY

5. HIGH PARITY (5 OR MORE)6. PREGNANCY OCCURING 3 MONTHS OR LESSAFTER LAST BIRTH


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PREGNANCY-INDUCED HYPERTENSION (PIH),

HYPERTENSION, KIDNEY DISEASE

1. Preeclampsia with hospitalization before labor

2. Eclampsia3. Kidney Disease-pyelonephritis, nephritis, nephrosis, etc

4. Chronic hypertension, severe (160/100mm Hg or over)

5. Blood pressure 140/90 mm Hg or above on 2 readings

30 minutes apart


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ANEMIA AND HEMORRHAGE

1. Hematocrit 30% or below in pregnancy

2. Hemorrhage (previous pregnancy)- severe, requiringtransfusion

3. Hemorrhage (present pregnancy)

4. Anemia (hemoglobin below 11 g) for which treatmentother than oral iron preparation is required (hemolytic,macrocytic anemias, etc)

5. Sickle cell trait or disease

6. History of bleeding or clotting disorder at any time


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FETAL FACTORS

1. Two or more previous preterm birth (twins=one birth)

2. Two or more consecutive spontaneous abortions (miscarriages)

3. One or more stillbirth at term gestation

4. One or more gross anomalies5. Rh incompatibilty or ABO isoimmunization problems

6. History of previous birth defect- cerebral palsy, brain damage,mental retardation, metabolic disorder such as phenylketonuria(PKU)

7. History of large infant (over 4032 gr)


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DYSTOCIA (HISTORY OF OR ANTICIPATED)1. Contracted pelvis or cephalopelvic disproportion (CPD)

2. Multifetal pregnancy in current pregnancy

3. Two or more breech births

4. Previous operative births (e.g cesarean or midforceps birth)

5. History of prolonged labor (more than 18 hours for nullipara; morethan 12 hours for multipara)

6. Previously diagnosed genital tract anomalies (incompetent cervix,cervical or uterin malformation, solitary ovary or tube) or problem

(ovarian mass, endometriosis)

7. Short stature (1.5 m or less)


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HISTORY OF OR CONCURRENT CONDITIONS

1. Diabetes ellitus, gestational diabetes

2. Hyperemesis gravidarum

3. Thyroid disease (hypothyroidism or hyperthyroidism)

4. Malnutrisi or extreme obesity (20% over weight for height; 15%under ideal weight for height)

5. Organic heart disease

6. Syphilis and TORCH infection, HIV positive, HPV

7. Tuberculosis or other serious pulmonary pathologic condition (e.g

emphysema, asthma)8. Malignant or premalignant tumors

9. Alcoholism, substance dependency

10. Psychiatric disease or epilepsy (documented)

11. Mental retardation


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THOSE WITH PREVIOUS HISTORY OF

1. Late registration, or poor clinic attendance

2. Family violence including battery, rape,incest

3. Home situation making clinic attendance and

hospitalization difficult4. Mothers, including minors, without family

resources


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FAKTOR-FAKTOR RESIKO YG MEMPENGARUHI

HASIL KEHAMILANPosisi dlm

Struktur sosial

Infeksi dan Pengalaman

Resiko lingk. masa kanak2

Status genetik st. psikologis pola budaya motivasi

st. kes & health practices

fisiologis slm care seeking

kehamilan Nutrition practices


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FAKTOR RESIKO SOSIAL

SOSIODEMOGRAFI : Usia : remaja, tua

SOSIOEKONOMI

Pendapatan, pendidikan, etnik

PERILAKU Perokok, alkohol, drug abuse

KETEGANGAN Perceraian, penyakit, kematian

PHK, kekurangan

Emosi, sikap


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APA YANG BISA DILAKUKAN?

1. Akses maternal health service

Basic maternal care

Penolong persalinan terampil

Pencegahan dan treatmen komplikasiselama kehamilan, persalinan dan masanifas

Postpartum family planningBasic neonatal care


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APA YANG BISA DILAKUKAN?

2. Perbaikan ketimpangan gender, kemiskinan dan

diskriminasi wanita

Meningkatkan status wanita

Meningkatkan peran wnt pd masa reprod. Meningkatkan produktifitas

Merubah pandangan pandangan keluarga dan

masy. Wanita sbg penerima jasa prwt ttp dapat

menentukan/memutuskan

Pengantar Maternitas II

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